Cause and Repair

Now, more than ever, attitudes about aging are being redefined literally, right before our eyes. Baby boomers know there is a possibility for a healthier, longer life span and want to look the part. But a youthful appearance isn't only about the surface of the skin. Nor is a well-rounded approach to rejuvenation simplistically skin deep. Time and sun damage take their toll upon each layer of the skin and its supportive tissues. To meet our expectations of ongoing youthfulness, rejuvenation must take into account all of our skin, outermost to inmost.

The Four Zones of Aging

With the passing years, changes occur simultaneously in four, vastly different "aging zones."

The Epidermis

Dryness, dullness, blotchiness and fine lines are the definitive aging concerns occurring in this outermost layer.

By age 30, the skin is becoming drier, as less sebum is produced. This escalates at menopause. Dryness may also be the source of increased skin sensitivity during this time.

The pigment-producing cells called melanocytes live in the basement layer of the epidermis. It is here that our skin color is produced. Over the years, the cumulative effects of the sun cause melanocytes to become more active. The resulting overproduction of melanin leads to blotchy discoloration and those large freckles (lentigos/lentigines) that frequently appear as we age.

Closer to the surface, the corneocytes (superficial epidermal cells) accumulate and the epidermis thickens. The final result: a dull, sallow, lifeless complex.

An anatomical prescription:

• Skin bleaching, as necessary. Think of DERMAdoctor Immaculate Correction Potent Hydroquinone-Free Skin Brightener as an ideal non-hydroquinone based option to address undesirable blotchy skin discoloration, freckles and melasma or ask your doctor about prescription bleaches such as Glyquin.
• Fine line therapy (AHAs, BHA, Retinoids). Here are a host of possible options. MD Formulations has many a wonderful treatment including MD Formulations Continuous Renewal Serum and MD Formulations Vit-A-Plus Intensive Anti-Aging Serum; DERMAdoctor offers DERMAdoctor Poetry In Lotion intensive retinol 1.0, while Peter Thomas Roth suggests Peter Thomas Roth Glycolic Acid 10% Moisturizer.


• Exfoliation. Think at home chemical peels (such as Dr. Dennis Gross Skincare Alpha Beta Daily Face Peel - 30 applications, microdermabrasion creams including DermaNew Facial Rejuvenation System and Dr. Brandt Microdermabrasion Exfoliating Face Cream or in office, physician-performed more powerful options.
• Hydration. It's not the amount of water that you drink but the amount of non-pore clogging moisturizer that's applied. The closer you get to menopause, the less protective sebum is made. Hence loss of the all important ceramide barrier. Remember that rejuvenation or other treatment products you apply to your skin may already be addressing this need. However, you may want to add a bit more. Consider Cellex-C Sea Silk Oil-Free Moisturizer or Cellex-C Hydra 5 B-Complex. The DERMAdoctor Wrinkle Revenge Duo may "do-it-all" for you, being a multifaceted approach by restoring the ceramide barrier plus handling other issues you'll see addressed later in "The Dermis".
• Sunscreen use and sun protection are daily essentials. Don't go outdoors without your DERMAdoctor Body Guard Exquisitely Light SPF 30 For Face & Body and a fashion statement sun-protective hat by Physician Endorsed.

The Dermis

Below the epidermis, the dermis is a busy place. There are tiny veins called capillaries, which bring blood flow to the skin. There are sweat glands, hair bulbs and nerve endings. And, of course, there are collagen and elastin fibers, which give strength and support to skin. Like the epidermis, the dermis undergoes major changes related to the aging process.

Collagen and elastin fibers begin to break down, leading to sagging, or "crepiness" of the skin. (Envision a chain link fencewith the links coming apart.) Compounding this, collagen- and elastin-producing cells called fibroblasts become far less active. Your skin can't make the amount of collagen fibers necessary to maintain your skin's status quo, let alone repair damage.

Sunlight also takes its toll on the dermis, damaging cellular DNA. This can lead to an increased formation of blood vessels, like spider veins on the face. To skin becoming more fragile and easily bruised. To thinning of the GAGs (glycosaminoglycans), a cellular component that helps give the skin overall structure. And to thinning of the extracellular cement, which holds cells together.

Some age-related lentigos are caused by melanin deposited into the dermis, similar to what is seen with some birthmarks. That is why the bleaching process can be so difficult (or even impossible) for some women.

An anatomical prescription:

• Antioxidants, to neutralize skin-damaging free radicals, stimulate fibroblast activity and help maintain and rebuild and dermis and extracellular cement. Cellex-C High Potency Serum is photoprotection with potent vitamin c. Other excellent antioxidants include N-6 Furfuryladenine (found in Kinerase Cream) and GHK Copper Peptides (found in Neova Creme De La Copper).
• Non-ablative lasers, to help stimulate collagen production.
• Injectable Fillers for deep, lower facial lines and lips or Rodial Glamoxy Snake Serum Pen that can temporarily plump up deeper lines on the face, neck and dcollet.
• Amino Acid Peptide therapy for face and eyes such as DERMAdoctor Wrinkle Revenge Duo, which helps kick-start the collagen production process, restores the fragile ceramide barrier often lost near menopause and is chock full of antioxidants (hence addressing concerns in the Epidermis, too).
• Thermage, to contract and tighten collagen fibers.
• Topical Vitamin A derivatives, like prescription Renova/Retin A, or their OTC cousins, retinols (like DERMAdoctor Poetry In Lotion intensive retinol 1.0), also have been rumored to have some of these fiber-stimulating properties, in addition to their exfoliating effects.

The Fat Layer

Below the dermal layer is a layer of fat. As we age, the fatty layer on the backs of the hands, the neck and the face becomes noticeably thinner. (We tend to add some weight with agingbut never where we want it!)

The results: More noticeable blood vessels on the backs of the hands. Dark circles exacerbated by fat pad atrophy beneath the eyes. Overall thinning of the skin, allowing for increased fragility. Fat will accumulate, however, along the jowls, creating the waddle (double chin) and "heavy" looking, sagging lower cheeks.

An anatomical prescription:

• Plump it up with fat transplants.
• Filler agents (injectable and implantable) here again Rodial Glamoxy Snake Serum Pen is an option. And don't overlook the benefits for helping temporarily restore some plumpness to the backs of the hands and an improvement in the appearance of wrinkles there, too.
• Liposuction of double chin.

The Muscle Layer

Below the fat lies muscle. Deeply grooved wrinkle lines on the face are caused by the buildup of facial muscles through overuse, typically smiling and frowning. Or chronic puckering from smoking, which can cause deep lines to form around the mouth. But even a non-smoking lifetime of puckering can eventually form these deep, crevice-like lines, particularly if there has been quite a bit of additional sun damage.

An anatomical prescription:

• Approved Botulinum Toxin A injections. Botox Cosmetic is now available; Dysport is the exciting new facial aesthetics product destined to hit the U.S. market sometime this next year provided it receives FDA approval.
• Laproscopic brow lift.
• Filler agents, for vertical lip lines. A product such as Rodial Glamoxy Snake Serum can be used as a needle-free temporary 24 hour approach to relaxing fine lines or it can help round out your injectable cosmetics product des jour.
• Feather lift, for brow wrinkles.

When it comes to skin rejuvenation, it's equally important to understand where the issue exists on an anatomical basis as it is to know what you are trying to accomplish. By doing this, you can match the therapy to the underlying problem. Don't let someone tell you that there is a single fix-it-all solution that tackles every mature skin issue. There isn't. Targeted treatment takes education and the ability to literally read between the lines. Otherwise, continuous bombardment by the hottest, hyped products may leave you with just a bottle of dreams.

For more information on skin rejuvenation, techniques, procedures and the hottest ingredients and their use, please consult my book The DERMAdoctor Skinstruction Manual: The Smart Guide to Healthy, Beautiful Skin and Looking Good at Any Age.

Thank you for taking the time to read my article. I hope you have found it informative.

Audrey Kunin, M.D.

(Any topic discussed in this article is not intended as medical advice. If you have a medical concern, please check with your doctor.)

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